Abstract | INTRODUCTION: In sepsis, severe reduction of afterload may often mask cardiac impairment. By establishing the parameter "afterload-related cardiac performance (ACP)" we wanted to determine the extent, frequency, and prognostic relevance of septic cardiomyopathy. METHODS: Over a 12 months period, all patients of our medical intensive care ward were included into the study when they were classified as having "septic MODS" ( sepsis score ≥12 as long as APACHE II score was ≥20). Hemodynamic assessments were performed using a pulmonary artery catheter. RESULTS: A total of 524 patients were screened, and from these 39 had septic MODS. In survivors, APACHE II score values declined from day 0 (day of diagnosis, 27.6 ± 8.0) to day 4 (17.8 ± 8.0), while in non-survivors, score values remained high (day 0: 31.8 ± 5.7; day 4: 33.2 ± 6.7; p < 0.001). Hemodynamic measurements showed an inverse correlation of cardiac output (CO(measured)) and SVR which can be described as CO = β (0) × SVR( β1). The upper limit of 80% tolerance range of CO was defined as the "normal" CO values (CO(normal)). The parameter "afterload-related cardiac performance (ACP)" was calculated as ACP (%) = CO(measured)/CO(normal) × 100. It turned out that ACP shows a stronger correlation with APACHE II- and sepsis-score than CO, cardiac index (CI), cardiac power (CPO), or cardiac power index ( CPI). Furthermore, ACP correlated with sepsis-induced myocardial damage as indicated by elevations of troponin I and significantly differed between surviving (86.9 ± 1.6%) and non-surviving patients (69.2 ± 1.4%; p < 0.0001). While 75% of the surviving patients showed an ACP >60%, 38% of the non-survivors had a moderate (ACP 40-60%) and 25% a severe impairment of cardiac function (ACP < 40%). CONCLUSION: By using the parameter "afterload-related cardiac performance, ACP", the impairment of cardiac function can be reliably quantified showing that septic cardiomyopathy occurs frequently and is of prognostic relevance in patients with septic MODS.
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Authors | Karl Werdan, Anja Oelke, Stefan Hettwer, Sebastian Nuding, Sebastian Bubel, Robert Hoke, Martin Russ, Christine Lautenschläger, Ursula Mueller-Werdan, Henning Ebelt |
Journal | Clinical research in cardiology : official journal of the German Cardiac Society
(Clin Res Cardiol)
Vol. 100
Issue 8
Pg. 661-8
(Aug 2011)
ISSN: 1861-0692 [Electronic] Germany |
PMID | 21308379
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- APACHE
- Cardiac Output
(physiology)
- Cardiomyopathies
(etiology, mortality, physiopathology)
- Female
- Hemodynamics
(physiology)
- Humans
- Male
- Middle Aged
- Multiple Organ Failure
(physiopathology)
- Prognosis
- Prospective Studies
- Sepsis
(complications, mortality, physiopathology)
- Severity of Illness Index
- Shock, Septic
(complications, mortality, physiopathology)
- Troponin I
(blood)
- Vascular Resistance
(physiology)
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